There is little more selfless than being able to give another family the gift of a baby. Whether they are facing infertility issues, are a same-sex couple, or a single parent going it alone, the road to parenthood can be a long and fruitless one, without the help of a special someone, willing to sacrifice their own body to bring such joy. There is no doubt that surrogacy is a deeply rewarding process, yet it is equally physically demanding, requiring tailored healthcare. Physiotherapists are becoming more and more essential in providing comprehensive pre- and postnatal care. From preparing the body for pregnancy to helping recovery after birth, physiotherapy offers practical solutions.

Surrogacy involves carrying a pregnancy with the goal of growing a child for another family. The physiological changes during pregnancy, such as weight gain, hormonal fluctuations, and shifts in the body’s centre of gravity, can strain muscles, joints, and ligaments. Added with the demands of labour and delivery, it can leave surrogates dealing with postpartum issues like muscle weakness, joint instability, and fatigue. Unlike traditional postnatal experiences, surrogates navigate recovery without the responsibilities of caring for a newborn. This difference can change recovery timelines and priorities, focusing more on physical rehabilitation to restore strength and function.

Common postnatal complications may include:

• Pelvic Floor Dysfunction: Weakness or damage to the pelvic floor muscles, which can lead to incontinence or prolapse.
• Abdominal Separation (Diastasis Recti): Separation of the abdominal muscles as they stretch through pregnancy, which can affect core strength and posture.
• Back and Hip Pain: Lingering discomfort due to pregnancy-related postural changes and strain.

With a proactive approach, physiotherapists can work to strengthen key muscle groups, alleviate discomfort, and promote overall health throughout the surrogacy journey to help manage these issues and any other complications that may arise.
Care begins with an assessment of the surrogate’s physical condition. Physiotherapists evaluate:

• Pelvic floor and core strength.
• Joint stability and posture.
• Pre-existing conditions that might influence pregnancy, such as back pain or prior injuries.

Based on this assessment, physiotherapists can develop a personalised care plan tailored to the surrogate’s needs. Physiotherapists guide surrogates through safe exercises such as:

• Pelvic Floor Exercises: To prevent incontinence and reduce the risk of prolapse.
• Core Activation Workouts: To maintain stability without placing pressure on the abdomen.
• Lower Back and Pelvic Pain: Stretching and strengthening exercises.
• Sciatica: Relieving pain with gentle stretches and posture adjustments.

Physiotherapists can also educate surrogates on proper posture to help with back and pelvic strain, reduce swelling, improve circulation in the legs and make them more comfortable across the nine months. They also help with safe exercise routines to keep up fitness and overall health. Combined, pre-natal physiotherapy allows surrogates to enjoy a healthier, more comfortable pregnancy, setting them up for smoother delivery and recovery.
The postnatal period is just as important, focusing on recovery from childbirth and restoring physical health. Physiotherapists play an important role, starting with an early assessment to determine areas of weakness in pelvic floor function, abdominal muscles and overall health, including posture, joint stability and mobility.

Physiotherapists provide:

• Targeted Exercises: Strengthening routines to restore pelvic floor function.
• Biofeedback Training: Using technology to help surrogates regain muscle control.
• Gentle Core Activation Exercises: To re-engage deep abdominal muscles safely.
• Progressive Workouts: Gradually increasing intensity as recovery progresses.
• Supportive Devices: Recommendations for abdominal binders or wraps if needed.

Unlike traditional postnatal care, rehabilitation for surrogates often prioritises their unique needs, which includes focusing on personal recovery timelines and goals, without the need for infant care. It’s important to recognise the emotional toll that surrogacy can take, especially in the postpartum period. Physiotherapy care extends to address this, working with other health professionals to ensure holistic care.

Surrogates typically return home without a newborn, which can lead to complex emotions such as a sense of loss, struggles to adjust to life after fulfilling their role, and body image concerns after pregnancy. While physiotherapists focus primarily on physical rehabilitation, their care can have significant emotional benefits:

• Guided exercises and improvements in physical strength can boost confidence and foster a sense of control.
• Relaxation techniques, such as breathing exercises and gentle stretching, can alleviate stress and anxiety.
• Physiotherapists often provide a supportive environment for surrogates to discuss their experiences, which can help with emotional healing.

Physiotherapists also work alongside other healthcare professionals for a comprehensive approach. They will refer surrogates for counselling and therapy, liaise with obstetricians and midwives for the continuation of care, and encourage support networks, such as surrogacy groups.

In Australia, the field of physiotherapy is well-equipped to address the specific needs of surrogates, offering accessible and high-quality care. Physiotherapy services for surrogates are available through various avenues, including:

• Public Healthcare: Many public hospitals offer pre- and postnatal physiotherapy programs as part of their maternity care services.
• Private Clinics: Surrogates can access specialised physiotherapy sessions tailored to their needs.
• Telehealth Services: For surrogates in rural or remote areas, virtual physiotherapy sessions provide expert guidance without the need for travel.

Physiotherapy plays an essential role in supporting surrogates through the unique challenges of their journey, from preparing for the physical demands of pregnancy to achieving a full and healthy recovery post-delivery. In Australia, surrogates can access a range of tailored physiotherapy services designed to address their specific needs, whether through public programs, private clinics, or telehealth options. Their holistic approach ensures that surrogates receive the specialised care they deserve for their selfless act.